International Growth Centre, Freetown, Sierra Leone.
Wageningen University and Research, Wageningen, The Netherlands.
Nature. 2024 Mar;627(8004):612-619. doi: 10.1038/s41586-024-07158-w. Epub 2024 Mar 13.
Less than 30% of people in Africa received a dose of the COVID-19 vaccine even 18 months after vaccine development. Here, motivated by the observation that residents of remote, rural areas of Sierra Leone faced severe access difficulties, we conducted an intervention with last-mile delivery of doses and health professionals to the most inaccessible areas, along with community mobilization. A cluster randomized controlled trial in 150 communities showed that this intervention with mobile vaccination teams increased the immunization rate by about 26 percentage points within 48-72 h. Moreover, auxiliary populations visited our community vaccination points, which more than doubled the number of inoculations administered. The additional people vaccinated per intervention site translated to an implementation cost of US $33 per person vaccinated. Transportation to reach remote villages accounted for a large share of total intervention costs. Therefore, bundling multiple maternal and child health interventions in the same visit would further reduce costs per person treated. Current research on vaccine delivery maintains a large focus on individual behavioural issues such as hesitancy. Our study demonstrates that prioritizing mobile services to overcome access difficulties faced by remote populations in developing countries can generate increased returns in terms of uptake of health services.
在非洲，即使在疫苗开发 18 个月后，也只有不到 30%的人接种了一剂 COVID-19 疫苗。在这里，鉴于塞拉利昂偏远农村地区的居民面临严重的获取困难，我们开展了一项干预措施，即向最难以到达的地区提供最后一英里的疫苗剂量和卫生专业人员，并进行社区动员。在 150 个社区开展的一项集群随机对照试验表明，这项由流动疫苗接种队提供的干预措施在 48-72 小时内将免疫接种率提高了约 26 个百分点。此外，辅助人群访问了我们的社区接种点，这使接种人数增加了一倍以上。每个干预点接种的额外人数意味着每人接种的实施成本为 33 美元。到达偏远村庄的交通费用占总干预费用的很大一部分。因此，将多种母婴健康干预措施捆绑在一次访问中，将进一步降低每人的治疗成本。目前关于疫苗接种的研究仍然主要关注个体行为问题，如犹豫。我们的研究表明，优先考虑流动服务以克服发展中国家偏远地区人口面临的获取困难，可以在卫生服务的使用率方面带来更高的回报。
